Weight Management:
Overweight, Obesity,
& Underweight
Chapter 9
Overweight and Obesity
• Major health problem in the U.S.
• Growing concern worldwide

• Prevalence continues to increase
...
Increasing Prevalence of
Obesity among US Adults
Fat Cell Development
• Energy in exceeds energy out
• Stored in fat cells of adipose tissue

• Body fat
• Number and size ...
Fat Cell Development
Fat Cell Metabolism
• Lipoprotein lipase (LPL) activity
• Storage of triglycerides
• Obese people vs. lean people
• Activi...
Causes of Overweight & Obesity
– Genetics & Epigenetics
• Causative role of genetics
• Genetic influences do seem to be in...
Causes of Overweight & Obesity
– Genetics & Epigenetics
• Obesity gene
• Codes for the protein leptin
• Acts as a hormone ...
Mice with and without Leptin
Compared
Causes of Overweight & Obesity
– Genetics & Epigenetics
• Obesity gene
• Genetic deficiency of leptin or genetic
mutation
...
Causes of Overweight & Obesity
– Genetics & Epigenetics
• Ghrelin
• Promotes positive energy balance
• Inverse correlation...
Causes of Overweight &
Obesity – Environment
• Encountered daily circumstances
• Interaction between environment and
genet...
Causes of Overweight &
Obesity – Environment
• Physical inactivity
• Life requires little exertion
• Modern technology

• ...
Problems of Overweight and
Obesity – Health Risks
• Three indicators
• BMI
• Waist circumference
• Disease risk profile
• ...
Problems of Overweight and
Obesity – Health Risks
• Overweight in good health
• Sometimes health is not the motivation for...
Problems of Overweight & Obesity
– Perceptions & Prejudices
• Most obese people do not successfully lose
weight and mainta...
The Psychology of Weight
Cycling
Problems of Overweight and
Obesity – Dangerous Interventions
• Intervention dangers
• Diet books and weight-loss programs
...
Aggressive Treatments for
Obesity – Drugs
• Strategies for weight reduction depend on:
• Degree of obesity
• Risk of disea...
FDA Approved Drugs for
Weight Loss
Aggressive Treatments for
Obesity – Surgery
• Clinically severe obesity
• 200,000 surgeries performed each year

• Reduces...
Gastric Surgery Used in the
Treatment of Severe Obesity
Weight Loss Strategies
• Successful strategies
• Small changes
• Moderate losses
• Reasonable goals
• Reasonable rate of w...
Reasonable Weight Goals vs.
Unrealistic Expectations
Weight Loss Strategies –
Eating Patterns
• Be realistic about energy intake
• Provide less energy than is needed
• Avoid r...
Weight Loss Strategies –
Eating Patterns
• Nutritional adequacy
• Minimum of 1200 kcalories a day

• Eat small portions
• ...
Weight Loss Strategies –
Eating Patterns
• Remember water
• Assistance with weight management

• Focus on fiber
• Low in e...
Weight Loss Strategies –
Eating Patterns
• Select carbohydrates carefully
• Artificial sweeteners
• Impact on energy intak...
Weight-Los Strategies
Weight Loss Strategies –
Physical Activity
• Best approach to weight management
• Moderate physical activity plus activiti...
Weight Loss Strategies –
Physical Activity
• kCalorie expenditure
• Body weight, intensity, and duration

• Greater the en...
Influence of Physical Activity
on Discretionary kCalories
Weight Loss Strategies –
Physical Activity
• Body composition
• Fat decreases and lean body mass increases
• Strength-trai...
Weight Loss Strategies –
Physical Activity
• Psychological benefits
• Self-esteem

• Choosing activities
• Ones you enjoy ...
Weight Loss Strategies –
Environmental Influences
• Factors surrounding eating experience and
the food itself
• Atmosphere...
Weight Loss Strategies –
Environmental Influences
• Socializing
• Duration of meal
• Visual cues
• Distraction

• Distract...
Weight Loss Strategies –
Environmental Influences
• Multiple choice
• Large assortments of foods increase
consumption

• P...
Weight Loss Strategies –
Behavior & Attitude
• Behavior modification
• Positive, matter-of-fact attitude

• Become aware o...
Weight Loss Strategies –
Behavior & Attitude
• Cognitive skills
• Problem solving
• Cognitive restructuring
• Replace nega...
Weight Loss Strategies –
Weight Maintenance
• Successful weight loss
• Plateau
• Appropriate goal at this point

• Prevale...
Weight Loss Strategies –
Weight Maintenance
• Components of successful weight loss
• Vigorous exercise regimens
• Careful ...
Preventing Weight Gain
• Preventing weight gain would benefit many
people
• Strategies are similar to losing weight
• Star...
Community Programs
• Possibly change environment through public
health law
• Stretch beyond individual
• Social networks
•...
Community Strategies to
Prevent Obesity
Underweight
• Affects no more than 2% of U.S. adults
• Weight gain is a matter of health
• Individual matter

• Weight gai...
Problems of Underweight
• Demand for energy contributes to
underweight
• Physical activity
• Growth and development

• Dif...
Weight-Gain Strategies
• Key diet planning strategies
• Adequacy and balance

• Energy-dense foods
•
•
•
•

Regular meals ...
The Latest and
Greatest WeightLoss Diet – Again
Highlight 9
Fad Diets
• Outrageous claims
• No requirements to prove the claims
• Do not have to support with credible research
• Dist...
Fad Diets’ Appeal
• Market for weight-loss products is huge
• Greatest appeal
• Tend to ignore dietary recommendations

• ...
Don’t Count kCalories
• Claim to disregard kcalories
• Designed to have low energy intake
• Tend to lack variety
• Monoton...
The Real Deal
• Fad diet “magical powers”
• Tipping the energy balance equation to
greater energy expenditure

• Weight lo...
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Chapter9

  1. 1. Weight Management: Overweight, Obesity, & Underweight Chapter 9
  2. 2. Overweight and Obesity • Major health problem in the U.S. • Growing concern worldwide • Prevalence continues to increase • Women, poor, blacks, and Hispanics • Children • BMI of 25 or greater • Epidemic is worldwide • Not merely among industrialized countries
  3. 3. Increasing Prevalence of Obesity among US Adults
  4. 4. Fat Cell Development • Energy in exceeds energy out • Stored in fat cells of adipose tissue • Body fat • Number and size of fat cells • Periods in life when fat cell numbers increase • Cell proliferation • Energy out exceeds energy in • Fat cell size decreases; no change in number
  5. 5. Fat Cell Development
  6. 6. Fat Cell Metabolism • Lipoprotein lipase (LPL) activity • Storage of triglycerides • Obese people vs. lean people • Activity in varying body regions • Men vs. women • Enzyme activity releasing and breaking down fat • Fat oxidation is not efficient • Set point theory
  7. 7. Causes of Overweight & Obesity – Genetics & Epigenetics • Causative role of genetics • Genetic influences do seem to be involved • Genetics may determine predisposition to obesity • Genes interact with: • Diet and physical activity • Satiety and energy balance
  8. 8. Causes of Overweight & Obesity – Genetics & Epigenetics • Obesity gene • Codes for the protein leptin • Acts as a hormone in hypothalamus • Promotes negative energy balance • Suppresses appetite • Increases energy expenditure • Locations of leptin secretion
  9. 9. Mice with and without Leptin Compared
  10. 10. Causes of Overweight & Obesity – Genetics & Epigenetics • Obesity gene • Genetic deficiency of leptin or genetic mutation • Rare • Leptin resistance • Fructose consumption • Roles in the body • Energy regulation • Others
  11. 11. Causes of Overweight & Obesity – Genetics & Epigenetics • Ghrelin • Promotes positive energy balance • Inverse correlation with body weight • Roles in the body beyond energy regulation
  12. 12. Causes of Overweight & Obesity – Environment • Encountered daily circumstances • Interaction between environment and genetics • Overeating • Present and past eating and activity patterns influence current body weight • Availability • Serving sizes • Restaurant food
  13. 13. Causes of Overweight & Obesity – Environment • Physical inactivity • Life requires little exertion • Modern technology • Inactivity contributes to weight gain and poor health • Sedentary activities and weight gain • DRI for prevention of weight gain • 60 minutes of moderate activity every day
  14. 14. Problems of Overweight and Obesity – Health Risks • Three indicators • BMI • Waist circumference • Disease risk profile • Factors taken into account • Beneficial weight loss • Health status • Motivation
  15. 15. Problems of Overweight and Obesity – Health Risks • Overweight in good health • Sometimes health is not the motivation for weight loss • Obese or overweight with risk factors • Two or more risk factors • Obese or overweight with life-threatening condition • Recommendation to lose weight
  16. 16. Problems of Overweight & Obesity – Perceptions & Prejudices • Most obese people do not successfully lose weight and maintain the loss • Social consequences • Jobs, school, and in social situations • Psychological problems • Embarrassment • Other feelings
  17. 17. The Psychology of Weight Cycling
  18. 18. Problems of Overweight and Obesity – Dangerous Interventions • Intervention dangers • Diet books and weight-loss programs • Little success with weight loss maintenance • Fad diets • Weight-loss products • Herbal products • Laws for dietary supplements • Other gimmicks
  19. 19. Aggressive Treatments for Obesity – Drugs • Strategies for weight reduction depend on: • Degree of obesity • Risk of disease • Use drugs as part of long-term comprehensive weight-loss programs • Assist with modest weight loss • FDA approval
  20. 20. FDA Approved Drugs for Weight Loss
  21. 21. Aggressive Treatments for Obesity – Surgery • Clinically severe obesity • 200,000 surgeries performed each year • Reduces food capacity of stomach • Effectively limits food intake • • • • Reduce production of ghrelin Health-related benefits Long-term safety and effectiveness Liposuction
  22. 22. Gastric Surgery Used in the Treatment of Severe Obesity
  23. 23. Weight Loss Strategies • Successful strategies • Small changes • Moderate losses • Reasonable goals • Reasonable rate of weight loss • Benefits of modest weight loss • Incorporation of healthy eating and physical activity
  24. 24. Reasonable Weight Goals vs. Unrealistic Expectations
  25. 25. Weight Loss Strategies – Eating Patterns • Be realistic about energy intake • Provide less energy than is needed • Avoid restrictive eating • Avoid rapid weight loss • Goal: nutritional adequacy without excess • Deficit of 500 to 1000 kcalories per day • Breakfast frequency • Inversely related to obesity
  26. 26. Weight Loss Strategies – Eating Patterns • Nutritional adequacy • Minimum of 1200 kcalories a day • Eat small portions • Eat less food at each meal • Feel satisfied, not stuffed • Structured meal replacement plans • Lower energy density • Cost
  27. 27. Weight Loss Strategies – Eating Patterns • Remember water • Assistance with weight management • Focus on fiber • Low in energy and high in nutrients • Require effort to eat • Speed of food consumption • Choose fats sensibly • Energy density and satiation
  28. 28. Weight Loss Strategies – Eating Patterns • Select carbohydrates carefully • Artificial sweeteners • Impact on energy intake • Watch for empty kcalories • Fat, sugar, and alcohol
  29. 29. Weight-Los Strategies
  30. 30. Weight Loss Strategies – Physical Activity • Best approach to weight management • Moderate physical activity plus activities of daily life • Combination of diet and physical activity • Lose more fat • Retain more muscle • Regain less weight • Reduction of abdominal fat
  31. 31. Weight Loss Strategies – Physical Activity • kCalorie expenditure • Body weight, intensity, and duration • Greater the energy deficit, greater the fat loss • Discretionary kcalorie allowance • Metabolism • Speeds up with activity • Immediate and long-term benefits
  32. 32. Influence of Physical Activity on Discretionary kCalories
  33. 33. Weight Loss Strategies – Physical Activity • Body composition • Fat decreases and lean body mass increases • Strength-training exercises • Abdominal fat • Appetite control • Delayed appetite • Inappropriate appetite
  34. 34. Weight Loss Strategies – Physical Activity • Psychological benefits • Self-esteem • Choosing activities • Ones you enjoy & are willing to do regularly • Low-to-moderate intensity • 2000 calories per week • Energy-expending daily activities • Spot reducing
  35. 35. Weight Loss Strategies – Environmental Influences • Factors surrounding eating experience and the food itself • Atmosphere • Pleasant and comfortable equals more food • Accessibility • Less effort needed to obtain food, more food eaten
  36. 36. Weight Loss Strategies – Environmental Influences • Socializing • Duration of meal • Visual cues • Distraction • Distractions • Initiating eating • Interfering with internal controls • Extending duration of eating
  37. 37. Weight Loss Strategies – Environmental Influences • Multiple choice • Large assortments of foods increase consumption • Package and portion sizes • Serving containers
  38. 38. Weight Loss Strategies – Behavior & Attitude • Behavior modification • Positive, matter-of-fact attitude • Become aware of behaviors • Keep record • Change behaviors • Set small, specific goals • Practice • Reward
  39. 39. Weight Loss Strategies – Behavior & Attitude • Cognitive skills • Problem solving • Cognitive restructuring • Replace negative thoughts • Personal attitude • Understand personal relationship with food • Sound emotional health • Support groups
  40. 40. Weight Loss Strategies – Weight Maintenance • Successful weight loss • Plateau • Appropriate goal at this point • Prevalence of successful weight loss • Difficult to determine • Weight loss • Without formal program • Maintained for at least a year
  41. 41. Weight Loss Strategies – Weight Maintenance • Components of successful weight loss • Vigorous exercise regimens • Careful eating patterns • Frequent self-monitoring • Changes in metabolism • Takes more to prevent weight regain than to prevent weight gain
  42. 42. Preventing Weight Gain • Preventing weight gain would benefit many people • Strategies are similar to losing weight • Start earlier
  43. 43. Community Programs • Possibly change environment through public health law • Stretch beyond individual • Social networks • Community institutions • Government policies
  44. 44. Community Strategies to Prevent Obesity
  45. 45. Underweight • Affects no more than 2% of U.S. adults • Weight gain is a matter of health • Individual matter • Weight gain may be difficult • Physical conditioning combined with high energy intakes
  46. 46. Problems of Underweight • Demand for energy contributes to underweight • Physical activity • Growth and development • Difficult to gain weight • Adaptive thermogenesis • Learn new habits and like new foods • Underweight vs. anorexia nervosa
  47. 47. Weight-Gain Strategies • Key diet planning strategies • Adequacy and balance • Energy-dense foods • • • • Regular meals daily Large portions Extra snacks Juice and milk • Exercise to build muscles
  48. 48. The Latest and Greatest WeightLoss Diet – Again Highlight 9
  49. 49. Fad Diets • Outrageous claims • No requirements to prove the claims • Do not have to support with credible research • Distorted research • Numerous fad diet plans
  50. 50. Fad Diets’ Appeal • Market for weight-loss products is huge • Greatest appeal • Tend to ignore dietary recommendations • Sophisticated and often erroneous explanations • Tend to work for short time • Fail to produce long-lasting results
  51. 51. Don’t Count kCalories • Claim to disregard kcalories • Designed to have low energy intake • Tend to lack variety • Monotonous • Often recommend dietary supplement • Follow a plan • Most fad diets cannot support optimal health over time
  52. 52. The Real Deal • Fad diet “magical powers” • Tipping the energy balance equation to greater energy expenditure • Weight loss • Long-term lifestyle changes • Healthy plan • Flexibility and variety

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